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Prevalence and outcomes for recurrent thyroid cancer
Vol. 213, No. 3S, September 2011
was to evaluate hernia recurrence rates following repair using SOP technique augmented with biologics. METHODS: We conducted an IRB approved level 2a study comparing prospectively a standardized cohort of patients (n⫽167) in whom ventral hernia repair was performed using SOP and various onlay biologics with a classical retrospective control cohort of patients (n⫽57) wherein only SOP was used. Deidentified data (demographics, recurrence, complications) was recorded over 3 years. Data was analyzed using ANOVA F test for continuous variables and Fisher exact test for categorical variables with p⬍0.05 as significant. RESULTS: There was no difference in demographic parameters between groups. Recurrence rate in SOP only group was 21.05% while that in SOP with biologics group was only 4.34% (p⬍0.05). Complications and hospital stay were comparable in both groups. CONCLUSIONS: SOP augmented with onlay biologics is a feasible, safe and effective method for repair of ventral hernias with the lowest reported rate of recurrence published in literature.
Parathyroidectomy for patients with normal initial intraoperative PTH levels Parth K Shah MD, Kinjal K Shah MD, Giorgos C Karakousis MD, Rachel R Kelz MD, Douglas L Fraker MD, FACS University of Pennsylvania School of Medicine, Philadelphia, PA INTRODUCTION: Primary hyperparathyroidism (HPT) is typically characterized by an elevated serum calcium, elevated PTH, and normal to elevated urinary calcium. A subset of patients with HPT has PTH levels within normal range but relatively high for the corresponding degree of hypercalcemia. We investigated changes in intraoperative PTH (IOPTH) levels in this group and corresponding pathologic findings. METHODS: From a prospectively maintained database of 2,050 patients undergoing parathyroidectomy by a single surgeon (19972010), we identified 42 patients with elevated preoperative calcium levels and normal initial IOPTH levels (12-65 pg/mL). Preoperative biochemistries, intraoperative findings and final pathological results for this group were collected. RESULTS: 38 patients (90%) had clinical symptoms related to hypercalcemia including renal stones, bone pain, osteoporosis and/or fatigue. Mean percentage drop in IOPTH levels was 61% from a mean initial IOPTH level of 54.1 pg/mL to a final IOPTH level of 20.9 pg/mL after abnormal gland(s) removal. 12 patients (29%) had
Surgical Forum Abstracts
S95
a drop ⬍50% in IOPTH. Pathologic distribution in overall group was as follows: 27 single adenomas (64%), 8 double adenomas (19%) and 2 four-gland hyperplasia (5%). 4 patients had a clinically abnormal gland removed but with final pathology revealing normocellular tissue; 3 of these had a ⬎50% drop in IOPTH levels into low normal range. All patients were normocalcemic post-operatively. CONCLUSIONS: Most patients with primary HPT and normal initial IOPTH will have single adenomas on final pathology. IOPTH is helpful although the standard criteria of IOPTH drop ⬎50% may not apply for an appreciable number of patients in this subgroup. Prevalence and outcomes for recurrent thyroid cancer Melissa M Boltz DO, Christopher S Hollenbeak PhD, Eric Schaefer MS, David Goldenberg MD, FACS Penn State Milton S. Hershey Medical Center, Hershey, PA INTRODUCTION: Although long-term survival of patients with well-differentiated thyroid cancer is common, little is known about the risk of tumor recurrence. We used data from the Surveillance Epidemiology and End Results (SEER) Medicare linked database to identify risk factors associated with recurrent thyroid cancer, and to assess the impact of recurrence on cancer-related and all-cause mortality up to five years following diagnosis. METHODS: We studied 5,391 patients diagnosed with a single primary thyroid cancer between 1995-2007. A recurrence was counted if the patient had evidence of iodine-131, imaging for metastatic thyroid carcinoma, or completion thyroidectomy beyond one month of diagnosis. Multivariate analyses of time to recurrence, time to death from cancer, and death from any cause were performed using Cox proportional hazards models, controlling for patient and disease characteristics and type of treatment received. RESULTS: Recurrence was observed in 1,355 (25.1%) of the 5,391 patients in the cohort. Older patients (hazard ratio [HR]⫽1.03, p⬍0.0001) with regional (HR⫽1.49, p⬍0.0001) or distant metastases (HR⫽2.34, p⬍0.0001) were at greater risk for developing recurrent disease. Papillary (HR⫽1.41, p⬍0.0001) and anaplastic histology (HR⫽3.4, p⬍0.0001) also indicated increased risk for recurrence. Patients with a recurrence were significantly less likely to die from cancer (HR⫽0.64; p⬍0.0001) than patients with no recurrence. They were also less likely to die from any cause (HR⫽0.70; p⬍0.0001). CONCLUSIONS: Despite an excellent prognosis, recurrence of thyroid carcinomas is not unusual. The protective effect of recurrence for mortality is most likely an artifact of a competing risk.
was to evaluate hernia recurrence rates following repair using SOP technique augmented with biologics. METHODS: We conducted an IRB approved level 2a study comparing prospectively a standardized cohort of patients (n⫽167) in whom ventral hernia repair was performed using SOP and various onlay biologics with a classical retrospective control cohort of patients (n⫽57) wherein only SOP was used. Deidentified data (demographics, recurrence, complications) was recorded over 3 years. Data was analyzed using ANOVA F test for continuous variables and Fisher exact test for categorical variables with p⬍0.05 as significant. RESULTS: There was no difference in demographic parameters between groups. Recurrence rate in SOP only group was 21.05% while that in SOP with biologics group was only 4.34% (p⬍0.05). Complications and hospital stay were comparable in both groups. CONCLUSIONS: SOP augmented with onlay biologics is a feasible, safe and effective method for repair of ventral hernias with the lowest reported rate of recurrence published in literature.
Parathyroidectomy for patients with normal initial intraoperative PTH levels Parth K Shah MD, Kinjal K Shah MD, Giorgos C Karakousis MD, Rachel R Kelz MD, Douglas L Fraker MD, FACS University of Pennsylvania School of Medicine, Philadelphia, PA INTRODUCTION: Primary hyperparathyroidism (HPT) is typically characterized by an elevated serum calcium, elevated PTH, and normal to elevated urinary calcium. A subset of patients with HPT has PTH levels within normal range but relatively high for the corresponding degree of hypercalcemia. We investigated changes in intraoperative PTH (IOPTH) levels in this group and corresponding pathologic findings. METHODS: From a prospectively maintained database of 2,050 patients undergoing parathyroidectomy by a single surgeon (19972010), we identified 42 patients with elevated preoperative calcium levels and normal initial IOPTH levels (12-65 pg/mL). Preoperative biochemistries, intraoperative findings and final pathological results for this group were collected. RESULTS: 38 patients (90%) had clinical symptoms related to hypercalcemia including renal stones, bone pain, osteoporosis and/or fatigue. Mean percentage drop in IOPTH levels was 61% from a mean initial IOPTH level of 54.1 pg/mL to a final IOPTH level of 20.9 pg/mL after abnormal gland(s) removal. 12 patients (29%) had
Surgical Forum Abstracts
S95
a drop ⬍50% in IOPTH. Pathologic distribution in overall group was as follows: 27 single adenomas (64%), 8 double adenomas (19%) and 2 four-gland hyperplasia (5%). 4 patients had a clinically abnormal gland removed but with final pathology revealing normocellular tissue; 3 of these had a ⬎50% drop in IOPTH levels into low normal range. All patients were normocalcemic post-operatively. CONCLUSIONS: Most patients with primary HPT and normal initial IOPTH will have single adenomas on final pathology. IOPTH is helpful although the standard criteria of IOPTH drop ⬎50% may not apply for an appreciable number of patients in this subgroup. Prevalence and outcomes for recurrent thyroid cancer Melissa M Boltz DO, Christopher S Hollenbeak PhD, Eric Schaefer MS, David Goldenberg MD, FACS Penn State Milton S. Hershey Medical Center, Hershey, PA INTRODUCTION: Although long-term survival of patients with well-differentiated thyroid cancer is common, little is known about the risk of tumor recurrence. We used data from the Surveillance Epidemiology and End Results (SEER) Medicare linked database to identify risk factors associated with recurrent thyroid cancer, and to assess the impact of recurrence on cancer-related and all-cause mortality up to five years following diagnosis. METHODS: We studied 5,391 patients diagnosed with a single primary thyroid cancer between 1995-2007. A recurrence was counted if the patient had evidence of iodine-131, imaging for metastatic thyroid carcinoma, or completion thyroidectomy beyond one month of diagnosis. Multivariate analyses of time to recurrence, time to death from cancer, and death from any cause were performed using Cox proportional hazards models, controlling for patient and disease characteristics and type of treatment received. RESULTS: Recurrence was observed in 1,355 (25.1%) of the 5,391 patients in the cohort. Older patients (hazard ratio [HR]⫽1.03, p⬍0.0001) with regional (HR⫽1.49, p⬍0.0001) or distant metastases (HR⫽2.34, p⬍0.0001) were at greater risk for developing recurrent disease. Papillary (HR⫽1.41, p⬍0.0001) and anaplastic histology (HR⫽3.4, p⬍0.0001) also indicated increased risk for recurrence. Patients with a recurrence were significantly less likely to die from cancer (HR⫽0.64; p⬍0.0001) than patients with no recurrence. They were also less likely to die from any cause (HR⫽0.70; p⬍0.0001). CONCLUSIONS: Despite an excellent prognosis, recurrence of thyroid carcinomas is not unusual. The protective effect of recurrence for mortality is most likely an artifact of a competing risk.